Provider Demographics
NPI:1679673578
Name:HUSAIN, SAMEERA (MD)
Entity Type:Individual
Prefix:
First Name:SAMEERA
Middle Name:
Last Name:HUSAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29211
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-9211
Mailing Address - Country:US
Mailing Address - Phone:212-305-2155
Mailing Address - Fax:212-927-9704
Practice Address - Street 1:630 W 168TH ST
Practice Address - Street 2:VC15-207
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3725
Practice Address - Country:US
Practice Address - Phone:212-305-2155
Practice Address - Fax:212-927-9704
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190589-1207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY80I083Medicare ID - Type Unspecified
NYF77364Medicare UPIN